Ignoring the Doctor

Hi All,
I have a long history with TMS, and I've been mired in this most recent struggle for nearly a decade now. About 2 months ago I experienced what one might call a 'flare', and my daily pain level became significantly more severe. Usually when I experience a notable increase in pain, I make a few adjustments - avoid sitting upright, start a course of oral steroids, take a few more pain killers, etc., and after a little while it usually settles back into about a 3.5 out of 10. I consider that to be my baseline pain level, but I do hate that 1-10 pain scale because it is so subjective.

Unfortunately this exacerbation is unique, because it's not gotten any better seemingly no matter what I throw at it, and it looks like I am settling into a 'new normal'. I went for a steroidal injection last week even though I've not experienced any improvement at all the last few times - just looking for any straw to grasp.

So here's the point: I went in to see the doc that did the injection for a follow up, and he told me that what he observed under fluoroscopy was 100% consistent with the symptoms I've been describing. He explained how he could see the herniated/protruding disc impacting the nerve. He recommended I see a surgeon, and gave me a referral. This is significant because he is the first out of countless doctors & specialists to ever make this statement. Over the years I've heard all of the same 'diagnoses' so many of us chronic low-back pain sufferers have all heard from doctors who have been trained to link any abnormality observed on an MRI to pain: Degenerative Disc Disease, Herniated Discs, Spinal Stenosis, Pinched Nerve, Congenital Spine Abnormalities, etc. I've also been told it is surely related to my Crohn's Disease.

After Dr. Sarno helped me banish my low back pain completely 23 years ago, whenever I'd hear a doctor mention any of those things, I would just call bullshit & follow the protocol: 'think psychologically', etc. Yet I've been completely unable to even make a dent in my pain by using the approach that worked the first time. This is the first time since then that I am feeling myself beginning to lose my faith in the diagnosis and start to consider that the cause may not be 100% psychological. I can't help but feel as though simply hearing the doctor utter these words has fed my TMS a big fat meal.

I've always insisted that I wouldn't consider surgery unless I could no longer walk. Yet I am finding myself more open to it these days. I am able to walk, but that's about it. My quality of life has deteriorated to a point that is just unacceptable, and I just can't live with this pain any longer.

So my question to the group is....what are the chances that a protruding disc could even possibly cause this? We all know the stats on back surgery, but if this guy thinks he can help me, and a 2nd opinion matches the 1st, I think I'd do it, because at this point I feel like I don't have much to lose. Arg.

 

Speaking from the other side of the fence because I had back surgery...I would keep talking to my subconscious for as long as it takes.

 

It's a tough spot to be in. Most of the time these things, especially bulging discs, are nothing other than incidental findings but occasionally they aren't. In the cases they are causing real structural issues, there would be a consistent and expected pattern that a good doctor could identify. Protruding discs really aren't usually the cause of chronic pain but they can be in rare cases...in fact in the few cases i've seen where they do cause structural issues, the people rarely had serious pain. If it was me, i'd consult a TMS doctor- some are available by Skype, or i'd even travel to one if I was able to to get a good opinion. There is one TMS doctor who is a spinal surgeon: David Hanscom: http://www.backincontrol.com (Back in Control – The DOC (Direct your Own Care) Project) is his website. Be careful with a 2nd opinion from a traditional surgeon.

 

Thanks MindBodyPT! Funny you should mention that. That was the first impulse I had once I really started feeling like I wasn't getting anywhere with my TMS treatment. I went to see Dr. Ira Rashbaum in NYC, the closest to what most consider to be the 'heir apparent' to Dr. Sarno. All I really wanted was for someone versed in Mind-body disorders to agree that my pain is rooted in the psychological . That kind of diagnosis is never 100%, but after telling him my story & undergoing a brief examination, he agreed that it is most likely TMS. He rubbed my back in a 'normal' area & then in the area where my pain is and showed me how it didn't turn red in the affected area because of the reduced blood flow. Not exact-science by any stretch, but certainly an indicator.

Here's the real problem....the phrase "it couldn't hurt to go in and see what the doctor says" is patently false. Throughout my history, I have most definitely been hurt by what doctors have told me, and at this point I've lost just about all faith in doctors and their ability to help me. It has gotten progressively worse over the years, but these days just finding a doctor who will return a phone call is impossible. Anyway, what if the surgeon looks at my back and tells me he can do a procedure that is likely to help. A 2nd surgeon says the same thing without communicating with the first. I'd be very tempted to go through with it, but the statistics on the success of any low-back surgery are just pathetic. So much so that I can't believe the AMA still allows it. Of course you never know which stats are accurate. I've had a number of surgeries in my lifetime and I can't say that I made a full recovery from any of them. There's always some kind of leftover nerve damage or ongoing issue that never goes away. Once I have surgery, any future TMS pain in the area will be confused with an issue related to the operation....although my 'TMS tools' are really useless these days anyway, so I guess there's nothing to lose.

Sorry for rambling - just thinking out loud. I am scared to death to let someone cut into my back, but my tank is on empty...no more fight left in me.

 

LOL, you make a good point, eightball - we say that too easily, don't we: "it can't hurt". Eesh. Because it can. Too many stories of failed surgeries. Even Consumer Reports, the magazine of the great American consumer, says "AVOID SURGERY!"

And yet, we also can't tell each other to NOT see a doctor - because ya never know.

But I'm with you on the lack of trust. I am 66, I have slight osteoporosis, which, in 8 years since my first bone scan at age 58, is essentially stable, thanks to more exercise and better supplements. Eight years ago my doc wanted immediately to put me on Fosamax - my immediate reaction being WTF!??? I will never take that crap! Her replacement wants to see me to discuss the latest results, "... which still show osteoporosis" and I know he wants to prescribe Fosamax, or similar - these are terrible drugs that produce a totally artificial bone-building environment that can backfire as necrosis. The retired doc said "oh, well, we avoid that by only prescribing it for five years". Seriously. That was supposed to convince me this is a legitimate medication?

Eesh.

 

In my case the answer to this question is zero chances. I had protruding disc. Three surgeon (not 2) told me surgery is the only way to cure my back pain. A week after I read Dr. Sarno's HBP I was cure.
I don't blame them doctors. Doctors are not dumb, they have to be very intelligent to get to where they are in life. I think they were just being trained and conditioned to think that way. Even today, after decades of curing myself of back pain, every time I went to my family doctor, he always ask me if my back is ok. He could not believe I have no pain with what he saw on my mri/x-ray. Usually doctors won't know anything about tms until tms happened to them It is up to the tms doctors and tms community to spread the word and teach the world about tms. It is our responsibility. I think it is a crime to cure yourself of tms then just disappear and not helping with spreading the message.

 

Back surgery has become so commonplace they even advertise it on TV like they were selling Twinkies--followed by TV commercials by ambulance chasing national "as seen on TV" law firms promising free money for failed surgeries, like hip replacements parts that can produce your own graphite--if you could bottle that you'd never have a sticky lock again, just stick your key into the keyhole surgical site to lube up--or the REALLY dangerous stuff like baby powder--where do I sign up for the free money for that one--and while I'm at it I'm gonna' sue my mommy for sprinkling it on my butt without having me sign a release first. In and out of a non-hospital surgical clinic in a day, and you're on your merry way to In&Out for a burger and shake. Dr. Sarno says surgery is our best placebo--reread your Sarno sounds like you need a booster. READ THE "DIVIDED MIND", Dr. Sarno's last of his four books which has the most up to date list of symptoms and the latest scientific evidence for TMS. Every question I've ever seen asked here is answered on every page.

 

According to Dr. Sarno, very little. Time to get out your Sarno books and look it up in the index. If you haven't cracked open your Sarno in 23 years you're due for a booster.

 

It sounds like you've gotten some good confirmation from seeing Dr. Rashbaum, which should help strengthen your beliefs. An important point to remember is that nothing is ever 100% with TMS, there is always grey area and you have to go with what you know to be best at the moment. I agree that getting more opinions from more doctors isn't always a good idea. It certainly doesn't sound like there is any indication for surgery or that it would even be worth consulting any sort of surgeon. The majority of people over 40 have bulged/herniated discs and are asymptomatic. Sounds like the best course of action is to keep working through TMS healing, ask any questions on here that you need to help strengthen your beliefs and knowledge!

 

If you're not already in therapy it's probably worth trying that first, to see if there's an underlying emotional issue you could discover and work through.

 

Funny you mention that...That is the last piece of advice given to me by Dr. Sarno himself after we exchanged letters a few years back. I'd written him asking his opinion on the relationship between my steadily worsening TMJ & TMS. He suggested I track down a good analytical psychologist to help me break the cycle & win the game of 'Whack-a-Mole', because he was confident that the pain in my jaw was another example of the 'Symptom Imperative', a phenomenon I'd unfortunately become intimately familiar with.

I began having panic attacks about 2 weeks after 'curing' my low back pain with Dr. Sarno's methods. Unfortunately, it took nearly two more years to reach the conclusion that seems so obvious in hindsight. At the time I didn't really know what 'anxiety' felt like, and blindly entered the mental health industry, which turned out to be not all that different from the modern back pain 'industry'. I was misdiagnosed over and over again, gave the psychotherapy a really good shot, but was only able to overcome the condition when I decided to use the same approach that'd fixed my back. I simply educated myself on the physiology, sources, etc. of Panic Disorder, and once I was able to convince myself of the benignant nature of these attacks, and where they were coming from, I made them disappear.

I tried therapy again more recently, attempting to focus solely on the mind-body connection, but it just didn’t take. I’m not one of those people that dismisses psychotherapy out of machismo or avoids it because of any lingering perceived stigma. I’ve given it a really good shot, with more than one provider, and have just concluded that it just isn’t helpful in my case.

On a side note, while I do believe TMJ is another TMS equivalent like Dr. Sarno theorized, yet I can’t explain why I began grinding my teeth as a toddler. Some doctors have suggested I was already internalizing any stress in my environment, even at that young age – or even absorbed my mother’s tension in the womb or as an infant. I had to call bullshit on that line of thinking, and just can’t wrap my head around the idea that I had repressed rage when I was a child.

There is definitely a psychological process that is very blatantly preventing me from really getting serious about following a TMS recovery program.

I am not a lazy person. You’d think that after 8-9 years of suffering that I would be relentlessly seeking to duplicate my past success. Re-reading Dr. Sarno’s books, etc., but my ‘ADD’, yet another TMS-equivalent, has me chasing my tail. I used to be a voracious reader, but over the last few years I’ve just watched my Amazon wish list grow and grow. I borrow library books again and again, yet allow them to expire without reading a page. I went out and bought ‘Zero Pain Now’ by Adam Heller (made it to chapter 3), along with the companion workbook (still filled with blank pages). I picked up ‘Unlearn your Pain’, just to name a few. I completed a month-long coaching program with Fred Amir (which I half-assed), and the list goes on. I bought a journal app and a symptom tracker, but eventually stopped keeping up with that too. I keep telling myself that I can’t complain about the pain or consider any kind of new treatment until I am doing absolutely everything I can to treat the TMS, but for some reason I can’t seem to summon the discipline. I have so much trouble concentrating, and once I’m finished with my work for the day, I just can’t get my brain going, and wind up just staring at the boob tube. So of course, I am extremely critical of myself for this, and generate a whole new round of rage/tension/perfectionism that feeds back into the TMS.

At this point I’ve missed so much of my life because of this back pain that every time I feel even just a little better, I find scramble to catch up. I tend to apply this losing philosophy to pretty much every aspect of my life, and it has turned into an unfortunate pattern I keep repeating year after year. My back feels better so I need to hurry up and get back into shape or enjoy my favorite sports/hobbies, which are all active & require physical strength. I then inevitably overdo it and wind up with some kind of stupid injury because my body doesn’t tell me when I’ve done too much at the time – it won’t be until the next day that I wind up crippled. Or I’ll obsess over work, and in my rush to ‘catch up’, I’ll neglect my body & spend too many hours SITTING at the computer and stop taking proper care of myself - eating bad takeout & not getting enough rest.

This is of course a losing proposition, and the concept that I’ve ‘missed out’ due to illness, whether TMS or the Crohn’s Disease I’ve had since age 6 is definitely a primary root cause of my TMS & repressed rage. Unfortunately, this time around, acknowledging the issue or ‘accepting the diagnosis’ isn’t enough to eliminate the pain.

I spoke to my pain management doc yesterday (he himself has undergone back surgery, though just based on what he’s told me, I’d say there is a significant chance he also suffered from TMS & his operation was unnecessary. I reminded him on several occasions that lots of people have ‘herniated discs’, but they don’t all develop chronic back pain. I did relent and agree to have a new imaging study done, mostly just to see if there has in fact been any kind of change in the pathology that can be identified as consistent with the progression of my symptomology. I am, however, terrified of what the radiologist will report, and am struggling to figure out the best way to prevent whatever horrifying diagnosis he comes up with from providing nourishment and strength for the TMS monsters inside my subconscious.

Just a quick side note to acknowledge what a truly special human being Dr. Sarno was. I recall being just blown away simply by the fact that I received a reply to my letter. It'd been a few years since I'd seen him in his office, and I live 2500 miles away. I nearly fell out of my chair when he called me directly to follow up. It is yet another example I wish more 'traditional' doctors would emulate. These days I consider it a small miracle to even get a call back from a medical assistant working for a local doctor's office where I am a current patient.

Wow, I’ve really rambled on a bit here. Thanks so much for all of the thoughtful replies. A special thank you to anyone that’s actually read this far! I scheduled my MRI for next week…

 

Hi eightball776,

When my root core TMS belief was questioned recently it became my main source of concern and attention. The anxiety produced kicked in my neck pain 10 fold resulting in more anxiety. I also have been away from TMS exposure for many years. Your story so far parallels mine.

To exist in the world of “trusting doctors” I coined the phrase 50/50, and reflect on my burst appendix incident. The examining doctor asked leading questions, and failed to order a simple blood test. My appendix burst the next day and I was carted off in the proverbial blood wagon. It was the doctor on call who drove 100 miles that saved me, for I would surely have died if it was not for his intervention. 50/50 keeps me from hate and bad feelings that sometimes clouds my TMS judgment. I am sure that everyone has had at least one thing good to say about non TMS doctors, but we seem to hate them here in chorus. One doctor failed me another served me.

In the year 2000 I had a miracle Dr. Sarno recovery. Like you I had severe back spasms for years and naively took his statement “resume all activity” literally. I chose to jog against my painful back in full spasm. I must have looked like an armadillo running sideways and I remember the jog vividly in rough terrain in the local park. The next day my spasms stopped for good. It was a good mistake; however it goes against TMS practices, but none the less worked for me. This recovery is the foundation of my TMS belief. Do you have one like this? It may help to review your past TMS recoveries.

Recently I have applied the 50/50 phrase to my TMS issues, for I have slight arthritis that I believe is the initial cause for the muscles in my neck to spasm. My first MRI in twenty years verified the exact arthritis location-protrusion of two bone spurs nudging against the spinal cord. The surgeon doctor knowing I was into “self care” said I would do well with PT. I fully understand that the TMS “nasty” would find this a comfortable pre defined residence, and utilize the workings of the body i.e. arthritis and muscle spasm to rage a riot.

The first laying of the hands of the therapist on my neck gave me instant relief, I nearly cried. This was the first time in twenty years I had sought mechanical help of any description, and have always been inwardly critical of the people here who seek “hand” help from Chiros and Acupuncts. There was a huge measure of mental relief that someone had verified the exact location and muscle, I felt vindicated. The respite from pain was very good for me also. I felt happy and physically comfortable. With a clear head I was able to consider the TMS side of the argument, the other 50% psychological. I believe my relief is only temporary since my neck issues are tension driven. I will finish PT in about four weeks armed with some new exercises that can incorporate into my Yoga routine.

My recovery in 2000 allowed me to take up windsurfing; it’s been 17 years of rigorous activity. You would be amazed how banged up I get. In order to survive I’ve tempered windsurfing backing off to 50%. The days of 8 hour windsurfing sessions have long past, but I am very happy with this quality over quantity ideaoligy, I give thanks for this, eat and nap instead.

In your last post you sounded lethargic when mentioning laziness. You have done the TMS rounds for years seeing numerous doctors for numerous ailments. You have nothing to lose by finding a hobby that gives you passionate happiness.

Thank you for your commentary, I did read to the end line.

 

It may be physically impossible for a herniated disk (soft tissue) to press on a nerve (soft tissue) with enough force to cause any pain whatsoever. However, the point of contact between nerve and herniation could provide a site where the central nervous system could locate pain caused by psychological stress. Besides, the prognosis for back surgery patients is so dismal that one wonders why they put themselves through such an unpleasant procedure with such a lousy outcome unless they're trying to solve some underlying psychological problem by physical means?

 

Hi Bruce,

I am discussing my neck in these comments:

Not only do I have the veritable herniated disc pressing on the central spinal nerve, but two nodules from the vertebrae, above and below the disc. These have been caused by the inevitable arthritis that comes with old age and an unusual bad curvature of my neck structure. The muscle adjacent to this area I have discovered recently is called the Levator Scapulae. A well know offender of spasms and neck pain. This is what I have nicknamed “Charlie” because it is like a “Charlie Horse”. Charlie rears his ugly head when I pull on his reins and get tense.

The surgeon-doctor said I would do well with PT which I am undertaking presently. I am having excellent results, but am having doubts about targeting pain etc. I do realize the relief is temporary since my tension is the long term issue. This I the first time I have targeted pain with physical activity in twenty years and the first time I have been checked out physically.

Regarding my tension I need a tension meter or something similar because there is a measure of tension both physical and mental in everything we do. It is hard to monitor tension because it’s impossible to think two things at once. Do you thing one of those emotion meters would help? My friend gave up smoking by flicking a rubber band on his wrist; he flicked it against his arm every time he had an urge to puff. He gave up smoking in two days. I am not the contraption type and wonder what Tennis Tom would say.


I live near Los Angeles ( The back surgery capitol of the world!)

 

It doesn't sound to me like any of the structural abnormalities you list would result in much pain if you didn't factor in what you call "tension". Sounds to me like LA wouldn't be as you put it, "the back surgery capitol (sic) of the world", if it weren't for stressful lifestyles factored in with the ready availability of surgeons ready to cure psychological problems by physical means. But, hey, didn't Los Angeles used to qualify as the Freudian psychotherapy capital of the world back in the Good Old Day in Gollywood?

I notice for example that some TMS patients focus on their pain symptoms to the point of obsession while others (like yourself) become obsessed with all the physical, structural causes they can find for generating their symptoms. I think Dr Sarno is right that you can't live in a halfway house between the psychological and the structural if you're going to address and solve a mind-body syndrome. You know your symptoms are due to something you term "stress" but keep going back to a list of physical causes for those same symptoms. You just can't have it both ways if you want to heal from TMS.

 

Hi Bruce,

Actually I don’t see myself as being obsessed with my physical symptoms, in fact quite the opposite. As I stated earlier this is the first time in many years I have looked the physical side. I wrote about this in another post earlier. Also I am not in pain presently, I am surprised as anybody to have gotten relief from mechanical-physical means, it was akin to taking a Tylenol PM.

I have for the most part been on the other forum since 2010 under the same name as here. Most of my Internet TMS history is over there, and hardly any of it is regarding the physical. So we are on the same page, but don’t know each other yet. By the way great Bio.

 

I had a similar experience to you, in that I was able to quickly cure my back/shoulder pain in about 6-12 months using Sarno's methods - but my nerve pain didn't seem to budge until this year. I had the nerve pain for about four years, and I think what cured it was actually getting into a good relationship and getting a lot of my emotional needs met, as well as letting go of old religious beliefs that held me back and created anxiety. I found that the usual TMS methods didn't seem to work as easily for the nerve pain, though I did find speaking to the pain helped whenever it started to creep back.

I noticed you have tried a lot of things so far, but have you considered looking into the role of trauma and the nervous system? I'd highly recommend reading more about somatic experiencing (Peter Levine), trauma release exercises (David Berceli) and also the blog/videos of Irene Lyons, who does a lot of work in this area using Feldrenkrais and SE.

 

Thanks everyone for your thoughtful replies & input. Reading other people's stories has always been a source of comfort for me. It can be easy to lapse into a 'this is only happening to me' mindset, and get annoyed by friends that happily spend zero attention or effort towards taking care of themselves and have more endurance, strength, and stamina than I could have hoped to achieve 15 years ago! I hear what you're saying about not living in the halfway house in between the physical and the psychological. I think I keep going back to the structural because I have had virtually zero success treating the psychological. The books don't help anymore, the work changing my thought patterns, etc. I know the 1st step is a complete acceptance of the diagnosis, but after a certain point I think my faith has begun to waiver, and I started looking at it maybe as a combination of factors that have gotten me to where I am today. Of course this makes it that much harder to treat, and is has been a catalyst for depression and additional stress/tension. The amount of pain that I've become accustomed to dealing with on a daily basis has reached a level of ridiculousness. I was that guy that viewed all MRI results with skepticism, swore I'd never consider surgery, and yet now I find myself scheduled for a new MRI next week. I am worried that if the right surgeoun sounds confident he can help me, I might just say screw it, let's try, because I don't know how much worse it can really get. I feel like a tiny increase in pain is going to land me back at home living with my parents or just totally unable to take care of myself. The laziness I described is simply another way I beat myself up about any reduced productivity that stems from illness or pain. This is at the heart of my TMS, my complete inability to accept any physical limitations, and the older I get, the more Father Time doles out for me. I had doctors telling me 25 years ago 'you're too young to be dealing with this crap'...it was almost a running joke. Now that I've crested 40, my subconscious rages about not really ever having a chance to be 'young and strong'. So yes, I am very in touch with my emotions, my repressed rage, and yada yada. Acknowledging it all, whether to myself or others, doesn't change my pain level one bit. I remain hopeful that there is an answer still yet to be found, and will always be a believer in Dr. Sarno's methods since my early success with it...but why the f&*k doesn't it work anymore??

 

Funny you should mention your age of 40 which is a milestone ? And doctors (white coats) mentioning your age....is all that stuck in your subconscious ? I was once told many years ago I would not totally recover from something and would have to accept some residual problems and it was the Mayo Clinic that said it. Well I recovered without any problems. But with that said I was also told that as I grew older it could relapse and it did. Did that creep into my subconscious and stay there for years when I reached 60 ? So I am currently working on what I believe is a TMS issue. Hang tough eight ball because like Sarno said "don't believe what you've been told". I am totally jealous that you met Dr. Sarno. Go back and read his letters because he could be speaking from the grave. Dr. Rashbaum worked with Sarno and wouldn't have told you his opinion to harm you. I had back surgery...do not do that to yourself unless you are having bowel and bladder issues. Remember people were carried into Sarno's office, crawled on their hands and knees and recovered. Do what it takes and remember maybe you are trying too hard & it's the fear that is getting to you. Fear of pain, of age, of whatever.

 

For sure that stuff is stuck rattling around in my subconscious. I don't put too much stock in 'turning 40', simply because this bout with TMS started long before then. This TMS 'flare' has been going on now since 2009. It began at the most unlikely time - I was getting comfortable at what I thought was a dream job in professional sports, was in the best physical shape of my life (in the gym 6 days/week), things were going well. I did have some 'emotional trauma' related to a beloved pet, which for me is definitely not insignificant, but I don't think that alone was what set this in motion. It's funny, although doctors would almost always comment on my youth, they almost never paid any attention to what I'd learned about managing this chronic illness over the last 30 or so years. My mother, who was my primary 'caregiver' throughout my adolescence, was diligent about managing my illness, but followed the doctors' orders without question - it could almost be considered blind faith. I still cringe when I recall listening to the top doctors in the field tell us that my diet had no bearing on this digestive illness I was battling. It sounds ridiculous when I look back on it, and it is unfortunate that we just didn't have the knowledge or tools they have today. I am having bladder & bowel issues to be sure. Are they related to my back pain? Is the terrible pain in my gut & inflammation in my intestines related to my back pain directly, and not just in that esoteric sort of 'systemic inflammation' sort of way? Maybe...but it depends on which doctor you ask. I've reached such a point of desperation where I see a placebo effect resulting from an unnecessary surgical procedure to actually be a positive result. The simple test that Dr. Rashbaum did in his office, where he rubbed the area on my back and demonstrated the difference in blood flow - well, that is why I can engage in some physical activity (not now, but when I'm less inflamed), allow my muscles to heat up, and actually manage to move around a bit without too much pain. My body doesn't tell me when to stop though, and once I cool down, I pay a heavy price for that activity. Slowly but surely I stopped engaging in just about every activity I enjoy because the price in pain just became too much to pay. It is easy to see where the cycle starts, repeats, etc., and what feeds into it. When I read Dr. Sarno's book for the 1st time, I saw my personality described on every page and had a real epiphany. Healing my pain back then was as close to a religious experience as someone like me will ever have. I felt like I'd reached a master level of understanding of my subconscious, and overnight I became an evangelist for his methods. Everyone I encountered who complained of some sort of persistent unexplained pain had to listen to my lecture about Dr. Sarno. I find that these days I hold back and don't give that speech anymore because I can't answer the obvious question I receive in response - "why do you still have such terrible back pain?". That is the conundrum that is sending me for a new MRI. What is missing from Dr. Sarno's book is an 'advanced course'. My TMS is just too engrained in my psyche at this point, and I just can't even make a dent. I've got the 'daily reminders' posted all over my house. Yet all attempts to return to physical activity have led to dismal failure and more suffering. Arg.